EHR
Implementation
by
Small
Primary
Care
Practices
Keith
T.
Kanel,
MD
MHCM
FACP
Chief
Medical
Officer
Pittsburgh
Regional
Health
Initiative
National
EHR
Acquisition,
Implementation,
and
Operations
Summit
San
Francisco,
CA
How
many
office
‐
based
practices
in
your
community
use
EHRs?
<
10%
20%
30%
40%
How
many
office
‐
based
practices
in
your
community
use
EHRs?
<
10%
20%
30%
9
40%
EHR
Adoption
by
Office
‐
Based
Physicians
Achieved
•
In
the
last
decade,
EHR
use
by
office
physicians
has
more
than
doubled.
EHR
Adoption
by
Office
‐
Based
Physicians
Desired
•
By
2014,
the
federal
government
has
set
a
goal
of
100%
adoption
of
electronic
health
records
in
the
United
States.
EHR
Adoption
by
Office
‐
Based
Physicians
Desired
•
Desired
growth
is
exponential,
not
linear.
The
traditional
pace
and
method
of
implementation
must
be
amplified
–
significantly.
Forces
Driving
EHR
Implementation
in
Office
‐
Based
Practices
1.
CMS
Meaningful
Use
incentives
¾
Providers
can
earn
up
to
$44,000
over
5
years
for
compliance.
¾
Must
begin
collecting
“meaningful
use” structured
data
by
10/1/11
to
leverage
full
Year
1
incentives.
2.
Regional
Extension
Centers
¾
RECs
incented
to
train
100,000
providers
by
2012.
¾
Services
highly
subsidized
to
eligible
providers
for
first
2
years.
3.
Corporate
consolidations
¾
50%
of
medical
practices
are
now
employed
by
Small
Primary
Care
Medical
Practices
•
70%
of
regional
medical
practices
have
5
or
fewer
physicians.
•
80%
of
regional
physicians
admit
to
only
one
hospital.
•
Most
practices
rely
on
debt
financing
of
major
capital
expenditures.
•
Smaller
practices
=
lower
EHR
implementation
rates.
0% 5% 10% 15% 20% 25%
1 2 3 4 5 6 7 8 9 10 11 1213151618 1921222528
Size of Physician Practice
Implementation
Rates
are
Lower
in
Small
Medical
Practices
How
many
office
‐
based
practices
in
your
community
use
EHRs?
<
10%
20%
30%
9
40%
Source: CDC/NCHS National Ambulatory Medical Care Survey http://www.cdc.gov/nchs/data/hestat/emr_ehr/emr_ehr.htm
Not
All
EHR
Implementations
in
Office
‐
Based
How
many
office
‐
based
practices
in
your
community
use
EHRs?
9
<
10%
9
20%
30%
9
40%
Variability
of
EHR
Functionality
Source: CMS EHR demo application results (113 practices using EHRs), Fall
2008.
Regional
Extension
Centers
•
Nationwide
support
to
providers
in
becoming
“Meaningful
Users”
of
HIT
through
comprehensive,
“on
‐
the
‐
ground”
services.
•
Support
targeted
at
primary
care
providers
“least
likely
to
achieve
Meaningful
Use
on
their
own:
•
Small
practices
with
<
10
providers
•
Critical
access
and
public
hospitals
•
Community
health
centers
and
rural
clinics
•
Pennsylvania
REC
(REACH
West)
established
to
move
3300
CMS
EHR
Demonstration:
Roll
‐
Out
•
Cycle
1
Community
Partners
(May
2009):
•
Cycle
2
Community
Partners
:
•
Alabama,
Delaware,
Georgia,
Maine,
Oklahoma,
Wisconsin,
Virginia,
Florida
•
Study
suspended
pending
deployment
of
HITECH
initiatives.
CYCLE
1
COMMUNITY
PARTNER
PRACTICES
Southwestern
Pennsylvania
279
Maryland/District
of
Columbia
255
Louisiana
204
South
Dakota/North
Dakota/Iowa/Minnesota
87
CMS
EHR
Demonstration:
Randomization
•
All
primary
care
practices
small
‐
medium
sized
with
<20
providers
(IM,
FP,
GP,
geriatrics).
•
Enrollment
of
1000
regional
physicians
(approximately
1/3
of
primary
care
providers
in
region).
CMS
EHR
Demonstration:
Maximum
Potential
Incentive
Payments
Year
EHR
Adoption
(OSS)
Reporting
of
Clinical
Measures
Performance
on
Clinical
Quality
Measures
Maximum/
Provider
Maximum/
Practice
1
$5,000
n/a
n/a
$5,000
$25,000
2
$5,000
$3,000
n/a
$8,000
$40,000
3
$5,000
n/a
$10,000
$15,000
$75,000
4
$5,000
n/a
$10,000
$15,000
$75,000
5
$5,000
n/a
$10,000
$15,000
$75,000
$58,000
$290,000
PRHI’s
Approach
to
Regional
Engagement:
“Transforming
Care
in
Provider
Practice”
•
Partnership
with
Highmark
BCBS,
the
dominant
regional
payer
for
the
Project.
•
Built
a
transformation
team
of
20
practice
coaches,
all
trained
in
Lean
Toyota
healthcare
methods
and
PCMH
transformation.
•
Develop
a
readiness
assessment,
work
plan,
and
project
timeline
built
from
existing
best
‐
practice
toolkits
(e.g.,
DOQ
‐
IT)
and
expert
private
consultants.
Approach
to
Small
Practice
EHR
Implementation
Unnecessary
steps
in
practices
that
have
already
implemented
an
EHR,
or
practices
in
communities
where
the
choice
was
pre
‐
determined
Readiness
Assessment
•
Can
you
afford
to
reduce
productivity
by
50%
for
at
least
one
month?
•
Is
now
the
time
to
do
this?
•
Will
you
need
a
new
billing
company?
•
Do
you
have
a
line
of
credit?
•
Should
you
do
a
total
or
scaled
implementation?
•
Have
you
planned
for
maintenance
fees,
interface
fees,
software
updates,
hardware
replacement?
•
Are
you
undercoding?
Standardized
Model
REC
Work
Plan
for
Office
Practices
with
No
Pre
‐
existing
EHR
DAYS
HOURS
PHASE
TASKS
3
3
Pre
‐
Work
HIPAA Business Associate agreement30
2
Complete
Work
Plan
Designate team and champions, Readiness Assessment; assembledemographic data
45
11
Office
Redesign
Workflow observations and adjustments82
3
Vendor
Preview
Define criteria, schedule and attend demos55
1
Vendor
Selection
Score demos, select finalists, negotiate contracts110
1
Hardware
Installation
Vendor training of staff, implementation120
9
Meaningful
Use
Align EHR use with MU objectives – 15 core and 5/10 menu55
Reporting
Meaningful
Use
Each EP registers with EHR Incentive Program website, submits
data by attestation (2011 only) or electronically
500
30
TOTAL
Work
plan
developed
for
Pennsylvania
REACH
West,
based
on
6
‐
year
experience
in
DOQ
‐
IT
program
involving
over
235
practices
and
1000
providers.
Work
plan
has
been
made
available
Standardized
Model
REC
Work
Plan
for
Office
Practices
with
No
Pre
‐
existing
EHR
DAYS
HOURS
PHASE
TASKS
3
3
Pre
‐
Work
HIPAA Business Associate agreement30
2
Complete
Work
Plan
Designate team and champions, Readiness Assessment; assembledemographic data
45
11
Office
Redesign
Workflow observations and adjustments82
3
Vendor
Preview
Define criteria, schedule and attend demos55
1
Vendor
Selection
Score demos, select finalists, negotiate contracts110
1
Hardware
Installation
Vendor training of staff, implementation120
9
Meaningful
Use
Align EHR use with MU objectives – 15 core and 5/10 menu55
Reporting
Meaningful
Use
Each EP registers with EHR Incentive Program website, submits
data by attestation (2011 only) or electronically
500
30
TOTAL
Between
5
‐
8
months
are
committed
to
selecting
a
vendor
and
installing
the
product
into
the
Standardized
Sample
Model
REC
Work
Plan
for
Office
Practices
with
Existing
Electronic
Health
Records
DAYS
PHASE
TASKS
3
Pre
‐
Work
HIPAA Business Associate agreement12
Complete
Work
Plan
Designate team and champions, Readiness Assessment; assembledemographic data
105
Office
Redesign
First conduct workflow observations and implement adjustments; second,review all EHR processes and upgrades, making recommendation to
optimize system.
40
Reporting
Stage
Develop /review processes for key reporting functions: e‐prescribingsend/print/check, laboratory data enter/retrieve, medication lists, problem
lists, produce reminders and prompts, identify specific patientsby disease.
40
Reporting
Meaningful
Use
Each EP registers with EHR Incentive Program website, submits data byattestation (2011 only) or electronically
